What is the AAP's counterpart in the UK?

[123]

On another site that I visit there is a father from Wales. He was complaining that he has heard of about 12 young boys who have been circ'ed for phimosis. He says that there is only one surgical team in his area. Obviously one of the doctors on it is either pro-circ or has discovered a cash cow.

Does anyone know what the UK's medical association says about age of retraction? I'd like to get an official link to send him. He thinks all this is absurd, but doesn't really know what to say to the other parents. Maybe a link contradicting the doctor(s) advice would make someone angry enough to file a complaint or something. He says most of the fathers of these boys don't like to talk about it, so obviously they're somewhat upset.

[Fellow Traveler]

Gosh how terrible. Well, I am not sure who would be directly involved but The British Medical Association states:

Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.

I am not sure of a good source for him but wouldn't one of the typical sources we use work?

[123]

You're probably right. I should find some studies showing what the normal age range for retraction is. I guess I was thinking that a statement by their own medical association might go further. But a well done study should be helpful as well. I'm off to find some.

[123]

Okay, this is what I wrote to him. I wonder if I missed any points I should have made. I mean, I don't want to tell him what to do. He wrote that blog as a general complaint, not a question of how to change the situation. I don't know. This is what I said:


Okay, so I looked some things up. The British Medical Association (which I'm assuming covers doctors in Wales) says:

3. CIRCUMCISION FOR MEDICAL PURPOSES
Unnecessarily invasive procedures should not be used where alternative, less invasive techniques are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate. Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision.5 Doctors should be aware of this and reassure parents accordingly. (http://jme.bmj.com/cgi/content/full/30/3/259)

Also it's been well established for some time that it's normal for boys to be non-retractable for most of their childhood. A Danish study from 1968 shows that the average age of retraction was 10.4 years. It can be found here http://www.cirp.org/library/general/oster/

Perhaps these parents should be aware that their doctor(s) aren't following the guidelines laid out by their own professional organization.

I found a good letter to the editor of The Journal of Medical Ethics which seems to be associated with The British Medical Journal. It addresses the problem that seems to be happening in your area. http://jme.bmj.com/cgi/eletters/31/8/463#2387

Sorry to be writing such a novel. This sort of thing just upsets me and I tend to react to stress by doing research. I hope some of this is helpful to you. If not, at least it reduced my stress level. :smile: I know how difficult it can be to deal with people who have listened to unwise medical advice and now feel compelled to justify that decision.

[Christine_T]

Originally Posted by 123

On another site that I visit there is a father from Wales. He was complaining that he has heard of about 12 young boys who have been circ'ed for phimosis. He says that there is only one surgical team in his area. Obviously one of the doctors on it is either pro-circ or has discovered a cash cow.

Does anyone know what the UK's medical association says about age of retraction? I'd like to get an official link to send him. He thinks all this is absurd, but doesn't really know what to say to the other parents. Maybe a link contradicting the doctor(s) advice would make someone angry enough to file a complaint or something. He says most of the fathers of these boys don't like to talk about it, so obviously they're somewhat upset.

In Britain - there is the National health service. It is the state run health service. So when people see their GP they are usually referred to a state run hospital for treatment. Nobody pays for it (except in taxes of course). Here are some good pages on the natural development of the foreskin and the care required:

http://www.cirp.org/pages/parents/care/

http://www.cirp.org/library/normal/

And this one is specific to phimosis and the phony phimosis diagnosis:
http://www.cirp.org/library/treatment/phimosis/

One of the men who studies this is AMK Rickwood (look at the references at the bottom) and he is from Britain.

Here is his most recent study:

http://www.bmj.com/cgi/content/full/321/7264/792

Here is his conclusion:

Too many English boys, especially those under 5 years of age, are still being circumcised because of misdiagnosis of phimosis. What is phimosis? At birth, the foreskin is almost invariably non-retractable, but this state is transient and resolves in nearly all boys as they mature. Such normality, with an unscarred and pliant preputial orifice, is clearly distinguishable from pathological phimosis, a condition unambiguously characterised by secondary cicatrisation of the orifice, usually due to balanitis xerotica obliterans.4 This problem, the only absolute indication for circumcision, affects some 0.6% of boys,4 peaks in incidence at 11 years of age, and is rarely encountered before the age of 5. 1 4 On this basis, the steeply falling circumcision rates among 0-4 year olds are readily explicable and lesser declines among 5-9 year olds are consistent with this group containing a proportion with pathological phimosis. Among 10-14 year olds, pathological phimosis is the predominant indication,1 thereby explaining the static rates of circumcision throughout England and their lack of geographical variation.

Recent trends are therefore consistent in direction, but not in extent, with the evidence base. Strictly, only some 0.6% of boys with pathological phimosis need to be circumcised,4 although more relaxed criteria would allow for a similar proportion affected by recurrent balanoposthitis.5 None the less, the trend towards evidence based practice already pays dividends. Circumcision costs about £500 as a daycase procedure, and some 10 000 fewer circumcisions in 1997-8 than in 1992-3 release £5m for other purposes. A reduction in the proportion of English boys circumcised to an attainable target of 2% would make for about 6000 fewer circumcisions each year, with a corresponding saving of £3m.